Childhood versus Adult

Tumors

CNS tumor histology and location are different in adult and children.

Tumor location and extent of spread affect treatment and prognosis.

Most common solid tumor in childhood.

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Childhood Brain Tumors

Meduloblastomas are the most common CNS histology in children.

50% are infratentorial.

Common infratentorial tumors:

•Cerebellar astrocytomas

•Meduloblastomas

•Ependymomas

•Brain stem gliomas

•Atypical teratoid tumors

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Cellular Classification

Childhood Brain Tumors (2)

The histopathology of childhood spinal tumors is the same as for childhood brain tumors.

Primary spinal cord tumors comprise approximately 1% to 2% of all childhood CNS tumors.

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Cellular Classification

Childhood CNS Tumors

Cause of childhood CNS tumors remains unknown.

American Academy of Pediatrics has outlined guidelines for pediatric cancer centers and their role in the treatment of pediatric cancer patients.

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ICD-O-3 Coding Issues (1)

Some histologies may be difficult to determine if the primary site is intracranial or the skull (C41.0).

Non-malignant tumors of the skull are not reportable.

•Chondroma (M9220/0) must originate in a brain-related site to be reportable.

•Chordoma (M9370/3) and chondrosarcoma (M9220/3) are malignant.

Tumors in brain-related sites are analyzed separately from those in the skull.

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ICD-O-3 Coding Issues (2)

Continue to assign histology code M9421/3 to pilocytic astrocytoma.

When the primary site for intracranial schwannoma (9560/0) is not documented in source documents, the site should be coded to cranial nerves NOS (C72.5).

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Grade for CNS Tumors

Sixth digit of ICD-O-3 histology code

•Describes tumor differentiation or grade.

•Is not usually specified for CNS tumors.

•Is always assigned code 9 for non- malignant CNS tumors:

Not determined, not stated, or not applicable.

Per ICD-O-3, page 30, Rule G, paragraph 1 “Only malignant tumors are graded.”

• Not the same as WHO grade.

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WHO Grade (1)

WHO grade coded in Collaborative Stage data field:

• Site-specific factor 1 for Brain.

Four-category tumor grading system

Grade I

Slow growingNon-malignant tumors

Patients have long-term survival.

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WHO Grade (2)

Grade II

Relatively slow growing

Sometimes recur as higher grade tumorsMay be non-malignant or malignant .

Grade III

Malignant tumors

Often recur as higher grade tumors.

Grade IV

Highly malignant and aggressive.

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